Blocked or damaged Fallopian tubes, also known as tubal factor infertility, accounts for around 25 to 30 percent of infertility cases and in fact in-vitro fertilization (IVF) was originally designed for these patients with this type of infertility. In women with damaged Fallopian tubes, the egg is either unable to be fertilized, in the case of complete blockage, or the fertilized egg cannot reach the uterus where it would usually undergo implantation. Consequently, in both cases, a normal pregnancy and birth are prevented.
Causes of blocked or damaged Fallopian tubes
The most common cause of blocked or damaged Fallopian tubes is pelvic inflammatory disease. This is an infection of the female reproductive organs and occurs when bacteria, most commonly Chlamydia trachomatis and Neisseria gonorrhea, spread from your vagina into your uterus, ovaries, and/or your Fallopian tubes. Unfortunately pelvic inflammatory disease often has no signs or symptoms and as a result you usually won’t know you have it and that you need treatment. Often you only realize that you have had pelvic inflammatory disease when you are trying to get pregnant at some point in the future or if you develop chronic pelvic pain.
Other common causes of blocked or damaged Fallopian tubes include:
- Endometriosis, a condition in which endometrial tissue that normally lines the uterus grows in other locations
- Ectopic tubal pregnancy, whereby the embryo implants somewhere in the Fallopian tubes and the tubes either rupture or develop scar tissue following medical treatment
- Previous surgery or other medical procedure, such as having your tubes clipped
How are blocked or damaged Fallopian tubes diagnosed?
The main symptom of blocked or damaged Fallopian tubes is the inability to become pregnant. There are two main tests that are used to diagnose tubal factor infertility:
- Laparoscopy, a minimally invasive surgical procedure which involves inserting an instrument through a small incision under the belly button that can view the Fallopian tubes
- Hysterosalpingogram, an X-ray-based procedure in which a dye is injected into the Fallopian tubes and tracked through the Fallopian tubes to see whether it comes out at the other end; however, the dye can only show if the tubes are open and it cannot show things like scar tissue which can have major effects on tubal function
Tubal damage or blockage can be categorized according to its location:
- Tubal blockage near the uterus is called proximal tubal blockage and is relatively easy to treat
- Mid-segment blockage is located in the middle of the Fallopian tube and often occurs following sterilization reversal
- Distal tubal blockage is located further from the uterus and in the wider part of the Fallopian tube
- Damage at the end of the Fallopian tube farthest from the uterus occurs in the fimbria, delicate finger-like tissue that sweeps the egg from the ovary into the Fallopian tube
Treatment of damaged or blocked Fallopian tubes
When it comes to treating infertility caused by blocked or damaged Fallopian tubes there are two main options – surgical procedures and IVF.
The surgical procedures are:
- Salpingectomy, the surgical removal of the damaged Fallopian tube and often done to remove an ectopic pregnancy
- Salpingostomy, the removal of tissue blocking the Fallopian tube (often an ectopic pregnancy) but not the whole tube
- Fimbrioplasty, a surgical procedure that repairs the damaged fimbriae; however this operation is only a good choice for patients with minimal fimbriae damage
- Tubal cannulation, a procedure which involves inserting a catheter guided by a wire and attached to a balloon into the Fallopian tube which is then used to unblock the target area
The other main option, IVF, is increasingly becoming the treatment of choice as the success rates for pregnancy continue to rise. In IVF the embryo is created in a laboratory and then inserted into a woman’s uterus, bypassing the tubes altogether.
When choosing between the two main options, several factors should be taken into account. These include:
- The age of the patient
- Ovarian reserve
- Site and extent of tubal damage
- Number of children desired
- Prior outcomes from infertility treatment
- Presence of other infertility factors
In addition, factors like religious belief, cost, and insurance reimbursement also factor into the decision about whether to undergo IVF or surgery. Patient preference is also taken into account when deciding between the two options. However, patients should be aware that surgery can result in even more damaged Fallopian tubes due to risk of more scar tissue forming. Surgery appears to be a good option in younger patients who have minimal scar tissue blocking the Fallopian tubes.